Subtle Signs ....

  1. I'm a critical care float pool nurse. I've just completed my cross training orientation, and will be staffing once or twice a week in the Extended Care Nursery. I wandered over here and have been mostly lurking in order to pick your brains for info

    I'm tasking adequately and still have a lot to learn ... one area I realized I need help with are recognizing those things that are second nature in my other patient populations... those subtle signs of impending change. In addition to the obvious 'big things' that my peers have been talking to me about, I'm looking for those 'little things' that newbies miss, but are so important to notice.

    In your experience, what are some of those little things that trigger your need to assess further?
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  2. 6 Comments

  3. by   Jolie
    Subtle changes in baby's temp. (or in the temp. the isolette must maintain in order to keep baby's reading stable), increases in apneic/bradycardic episodes, slight color changes (more pale or mottled than before), increased residuals, increase in abdominal girth, taut, shiny or rope-like appearance of the abdomen, increased irritability or increased lethargy.

    ANY time a parent tells you that something is "off" with their baby, believe them and investigate.
  4. by   NurseKymba
    Thanks Jolie!

    I've already had a full term baby act up on me ... mottling wasn't exactly subtle (and neither were the alarms) ... and it led me to ask. Some of the stuff you mentioned I never would have thought of - so perfect! In adults, I have that gut feeling that I can trace back to physical 'things' that trigger my need to follow up. With this population of babies, I have no gut feeling! That has me the most scared about helping for the next few months ......

    So thank you for taking the time to respond to my question :smilecoffeecup:
  5. by   Jolie
    You have my admiration for being brave enough to care for a patient population so far out of your usual realm. Adults scare the c**p out of me! Good luck!
  6. by   NurseKymba
    These munchkins USED to scare me! So I understand completely about your dislike of caring for adults.

    I worked my first shift off of orientation and thrived, so thank you again for your tips ... I'll continue lurking in this board to continue picking more experienced brains.

    Thank you again, you rock!

  7. by   KRVRN
    A blood sugar of 200+ just randomly, out of no where.

    WBCs dropping on a CBC.

    That icky, ill-perfused, pale mottled color.
  8. by   RainDreamer
    Quote from KRVRN
    A blood sugar of 200+ just randomly, out of no where.
    I had a kid like this a few months ago .... a new 24 weeker. I got a blood sugar of like 210 .... just outta nowhere, whereas before it was normal. Further investigating told us the kid blew his head ..... 6 hours later he was dead.

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